Reforms Urged For Nursing Homes

LISA CHEDEKELThe Hartford Courant

Saying that Haven Healthcare's troubled record should serve as a wake-up call, state Senate leaders on Wednesday proposed a package of nursing-home reforms aimed at boosting staffing, improving financial accountability and increasing public scrutiny of the state's 240 licensed facilities.

Among the proposals is one that would require the state Department of Public Health to prepare consumer-oriented "report cards" on nursing homes that would include detailed data on staffing and state inspection results. Other proposals are aimed at improving the financial oversight of homes, which receive about $1.4 billion a year in state Medicaid money.

"We are fourth in the country on what we spend per capita on nursing-home care. The resources are there, but we have to be sure that the outcomes" are serving residents, said Senate President Pro Tem Donald E. Williams Jr., D-Brooklyn, who was joined at a press conference by Majority Leader Martin M. Looney, D-New Haven, and four other Democratic senators.

The most far-reaching reform would update the minimum-staffing requirement in the state's public health code, which has not been changed in more than 25 years. The existing rule calls for homes to provide a minimum of 1.9 hours of nursing care per resident per day - less than half of what a study commissioned by the federal Centers for Medicare & Medicaid Services recommends. Past efforts to raise the state minimum have failed.

Under the current minimum, homes are required to provide one nursing assistant for every 14 residents during the day. State Sen. Edith Prague, D-Columbia, said that she wants the state to move toward requiring one aide for every five residents.

"For me, this has been an issue for a long time," said Prague, who has pushed for years to increase the staffing requirement. "I think we'll see some dramatic changes, and it's about time."

Lawmakers noted that most Connecticut nursing homes staff well above the existing minimum, providing an average of 3.6 hours of care per resident per day. But they said that the outdated code gives nursing homes wide discretion to operate with reduced staffing.

The senators acknowledged that boosting the minimum would require millions of dollars in state Medicaid funding at a time when Gov. M. Jodi Rell is calling for controlling costs. They have not yet put a price tag on the staffing initiative.

Other proposals to increase oversight and financial accountability were prompted by revelations of serious patient-care and financial problems at Haven Healthcare, which declared bankruptcy in November after a series in The Courant detailed the chain's troubled regulatory record. Some of Haven's 15 Connecticut homes had been cited repeatedly by state health inspectors for serious violations, while bills for supplies and utilities went unpaid. Meanwhile, the chain's owner used millions of dollars in corporate assets to launch a Nashville recording company and make other purchases.

A court-appointed financial officer and patient-care ombudsman are now overseeing Haven. The chain's long-term fate remains uncertain. The FBI and other agencies have seized Haven documents in an investigation of possible Medicaid and Medicare fraud and tax fraud. Haven CEO Raymond Termini has denied any misuse of state or federal funds.

Williams referenced the tale of Haven by citing a country music title, "Your Cheating Heart," saying that reforms are needed to ensure stricter oversight of state money.

"We want to end the shell game," he said. "We think [taxpayer money] is going to quality care; it goes elsewhere, to other investments."

He and the other leaders called for the creation of a nursing home oversight board, with the state comptroller as chairman, that would work with the public health and social services departments to identify troubled homes and improve financial reporting. They also called for expanding the financial information that nursing homes are required to report to the state, to ensure that owners disclose the finances of "related corporate entities."

To help improve cash flow to homes, the senators want the state to set aside a pool of Medicaid funding that could be advanced to homes while they are waiting for residents' Medicaid eligibility to be validated.

Last week, state social services officials announced that a second Connecticut nursing home chain, Marathon Healthcare, was in financial straits.

The senators said they were concerned that the state's licensing and inspection procedures were failing to adequately safeguard residents' safety, but they did not propose specific changes. They said that they were considering requiring homes to seek outside accreditation, as an additional check on quality.

Representatives of both the nursing home industry and union employees said they support the proposals - although both said that the proposed staffing increases would require a significant infusion of state money.

"This is some good stuff. There's nothing here that my members can't support," said Toni Fatone, executive director of the Connecticut Association of Health Care Facilities. "The vast majority of nursing homes in this state are already doing these things."

Deborah Chernoff, a spokeswoman for the New England Health Care Employees Union, District 1199, said that the push to expand owners' financial reporting is important as big chains and private equity firms take over a larger share of the industry.

"Many of the larger nursing home companies have created complex corporate structures with many related entities that provide services to the homes," she said. "But the books of those related entities are closed to the state - and everyone else. That means it's difficult for states to know and evaluate the real financial condition of the company."

At Wednesday's press conference, the family of a New Britain man who went into a nursing home to recuperate from a fall last year issued an appeal to lawmakers to improve patient care. John Krawczyk, 76, died of a massive infection in December after the nursing home, which the family did not identify, ignored repeated signs that he was deteriorating, said family member Joyce Fontana, an assistant professor of nursing at St. Joseph College in West Hartford.

Fontana said that the case, which did not involve a Haven home, was just one example of "systemic problems" with nursing home care, and she urged lawmakers to "act now" to add staffing and hold homes accountable for negligent care.